Showing papers by "William Small published in 2007"
TL;DR: Surfaces doses can be reduced if radiologic technologists can better center patients within the CT gantry and result in as much as 30% reduction in surface dose.
Abstract: OBJECTIVE The purpose of this study was to determine with phantom and patient imaging the effect of an automatic patient-centering technique on the radiation dose associated with MDCTSUBJECTS AND METHODS A 32-cm CT dose index (CTDI) phantom was scanned with 64-MDCT in three positions: gantry isocenter and 30 and 60 mm below the isocenter of the scanner gantry In each position, surface, peripheral, and volume CTDIs were estimated with a standard 10-cm pencil ionization chamber The institutional review board approved the study with 63 patients (36 men, 27 women; mean age, 51 years; age range, 22-83 years) undergoing chest (n = 18) or abdominal (n = 45) CT using the z-axis automatic exposure control technique Each patient was positioned according to the region being scanned and then was centered in the gantry Before scanning of a patient, automatic centering software was used to estimate patient off-centering and percentage of dose reduction with optimum recentering Data were analyzed with linear cor
195 citations
TL;DR: Extended field and intracavitary irradiation with cisplatin for para-aortic or high common iliac metastasis from cervical cancer is associated with significant acute and late toxicity.
Abstract: Purpose: The Radiation Therapy Oncolology Group (RTOG) 0116 trial was designed to test the ability of Amifostine to reduce the toxicity of combined chemotherapy with extended-field radiotherapy and brachytherapy (Part 2), after first determining the toxicity rate for the regimen without Amifostine (Part 1). This manuscript reports the results of Part 1. Methods and Materials: Eligibility included patients with cervical carcinoma and high common iliac or para-aortic metastasis. Patients received extended-field radiotherapy to 45 Gy (1.8 Gy/fraction) with intracavitary irradiation. The final point A dose was 85 Gy LDR equivalent. Use of HDR was allowed. The positive para-aortic and high common iliac nodes were boosted to 54 to 59.4 Gy. Cisplatin (40 mg/m2) was delivered weekly during external beam and once with brachytherapy. The primary endpoint of Part 1 was acute Grade 3/4 toxicity, excluding Grade 3 leukopenia. Results: A total of 26 eligible patients were entered between August 1, 2000, and Decemeber 3, 2003. Of these, 21 had para-aortic metastasis (15 also had high common iliac involvement), and 5 had high common iliac involvement only. The median follow-up was 17.1 months (range, 1.8–38.6 months) for all patients and 21.7 months (range, 11.4–38.6 months) for alive patients. The acute Grade 3/4 toxicity rate, excluding Grade 3 leukopenia was 81%. Late Grade 3/4 toxicity was 40%. Eight patients underwent surgery for complications. Sixteen (62%) patients had a complete response for both local and nodal disease. The complete local response was 92%, the complete overall nodal response rate was 62% and the regional and para-aortic nodal response rates were 60% and 71% respectively. Estimated disease-free and overall survival at 18 months are 46% and 60%. Conclusions: Extended field and intracavitary irradiation with cisplatin for para-aortic or high common iliac metastasis from cervical cancer is associated with significant acute and late toxicity.
129 citations
TL;DR: Complete pathologic responses after surgery were frequent and although pathologic T stage after surgery did not affect recurrence rates, pathologic nodal response was associated with improved recurrence and survival rates.
Abstract: Background Our goals were to examine the impact of neoadjuvant chemoradiation for rectal cancer on surgical outcomes and to determine prognostic factors predicting improved survival. Methods Retrospective cohort of 56 male and 44 female patients. Results After preoperative chemoradiation, 73% of patients had sphincter-preserving surgery. The 5-year disease-free (DFS) and overall survival rates were 77% and 81%, respectively. Twenty-five percent of patients showed a complete pathologic response. T-level downstaging and pathologic T stage did not correlate with recurrence or survival rates. Pathologic nodal stage was associated with a significant difference in recurrence rates (N 0 19%, N 1 20%, and N 2 75%, P = .038) and DFS (N 0 /N 1 vs. N 2 , 79% vs. 25%, P = .002). Conclusion Neoadjuvant chemoradiation resulted in a high rate of sphincter preservation. Complete pathologic responses after surgery were frequent and although pathologic T stage after surgery did not affect recurrence rates, pathologic nodal response was associated with improved recurrence and survival rates.
62 citations
TL;DR: The spectrum of imaging features of hypervascular liver lesions is discussed, including hemangioma, focal nodular hyperplasia, hepatocellular adenoma, liver cancer, and metastases from primary tumors such as islet cell tumor, carcinoid, renal cell carcinoma, melanoma, and thyroid carcinoma.
36 citations
TL;DR: At 2 years, the estimated disease-free survival and overall survival rate for patients with advanced cervical cancer who underwent a combination of chemoradiotherapy and celecoxib treatment was 69% and 83%, respectively.
Abstract: Purpose To determine the efficacy and patterns of initial failure for oral celecoxib, intravenous cisplatin, and 5-fluorouracil and concurrent pelvic radiotherapy in patients with locally advanced cancer of the cervix. Methods and Materials Patients were treated with concurrent 5-fluorouracil and cisplatin chemotherapy and pelvic radiotherapy and brachytherapy. Celecoxib was prescribed at a dose of 400 mg twice daily for 1 year beginning on the first day of radiotherapy. The overall and disease-free survival rates were determined. Results A total of 84 patients were accrued, of whom 78 were eligible. The estimated 2-year disease-free survival and overall survival rate was 69% and 83%, respectively. Of the 78 patients, 24 had treatment failure: 3 with persistent local disease, 9 local only, 2 regional, 4 distant, 1 regional and distant, 1 local and distant, and 2 with local, regional, and distant disease, and 1 had died of cervical cancer without a reported site of first failure and 1 without evidence of disease. Conclusion At 2 years, the estimated disease-free survival and overall survival rate for patients with advanced cervical cancer who underwent a combination of chemoradiotherapy and celecoxib treatment was 69% and 83%, respectively. Recurrent disease developed in 24 patients, and, of those patients, 18 had a component of locoregional failure as a site of first failure. Thus, locoregional control continues to be problematic after chemoradiotherapy as delivered in our study. The identification of more active biologically targeted therapies is warranted for the treatment of advanced cancer of the cervix.
33 citations
TL;DR: Palliative radiotherapy is a very effective tool in alleviating pain symptoms and generally well tolerated, and site-specific treatment is addressed, divided into palliatives radiotherapy for brain metastases, spinal cord compression, and bone metastases.
Abstract: Radiation therapy plays an important role in both curative and palliative cancer treatment. Palliative radiation therapy is given to alleviate symptoms, restore function, relieve suffering caused by cancer, and improve quality of life. Pain relief, control of bleeding or ulceration, prevention of impending compression or obstruction from tumor, and shrinkage of tumor masses causing symptoms are indications for palliative radiotherapy. Palliative radiotherapy is a very effective tool in alleviating pain symptoms and generally well tolerated. Common fractionation schemes are 8 Gy delivered in one fraction and 30 Gy delivered in 10 fractions. This article discusses general principles of administering palliative radiation therapy. Site-specific treatment is addressed, divided into palliative radiotherapy for brain metastases, spinal cord compression, and bone metastases. In each of these areas, we discuss presentation, management, and therapeutic strategies.
19 citations
16 citations
TL;DR: Independent coronal multiplanar reformatted images obtained using state-of-the-art MDCT scanners show promise as the preferred orientation and can be useful for primary interpretation of MDCT of the abdomen and pelvis.
14 citations
TL;DR: A combined approach where both data sets are simultaneously available is therefore preferred, as the use of MPR images alone resulted in an unacceptably high number of missed soft tissue and even skeletal findings.
Abstract: To assess whether independent evaluation of coronal and sagittal reformatted images can replace axial images for primary interpretation of multidetector row computed tomography (MDCT) images in patients with thoraco-abdominal trauma. 111 (M/F 69:42) patients with acute chest or abdominal trauma underwent 16-channel MDCT. Coronal and sagittal multiplanar reformatted (MPR) images were generated from thin-section axial images. Two radiologists independently interpreted the MPR images first followed by axial images for both imaging findings as well as adequacy of image quality. Differences between independent reader review of axial and MPR images were assessed using the Wilcoxon signed rank test. There was no significant difference in soft tissue findings identified on MPR vs axial images for either reader, p = 0.91 and 0.34, respectively. However, both readers identified more skeletal findings on the MPR as compared to the axial images, p = 0.026 and 0.040, respectively. There was no significant difference between the readers in their interpretation of axial (soft tissue, p = 0.56; skeletal, p = 0.65) or MPR (soft tissue, p = 0.32; skeletal, p = 0.65) findings. More skeletal findings were identified during the isolated review of MPR as compared to axial images alone. However, the use of MPR images alone still resulted in an unacceptably high number of missed soft tissue and even skeletal findings. A combined approach where both data sets are simultaneously available is therefore preferred.
12 citations
Journal Article•
TL;DR: Survival for patients with inoperable pancreatic cancer continues to be poor, and future investigations need to focus on understanding the molecular nature of this malignancy, with the goal of developing interventions based on this knowledge.
Abstract: Inoperable pancreatic adenocarcinoma is a dilemma that oncologists frequently encounter. Only 15% to 20% of patients are diagnosed when cancer of the pancreas is still surgically resectable. However, pancreaticoduodenectomy is the only curative option for this disease and should be offered to all patients who meet resection criteria and do not have significant comorbidities. For inoperable pancreatic cancer, the goals of treatment are to palliate symptoms and prolong life. Improved survival in locally advanced disease has been demonstrated with chemoradiation plus fluorouracil or with gemcitabine (Gemzar) alone. In metastatic disease, single-agent gemcitabine has been associated with improvement in symptoms and survival. Trials combining various chemotherapeutic agents with gemcitabine have not had a significant impact on overall survival, although meta-analyses suggest a small benefit. The targeted agent erlotinib (Tarceva) has shown a modest improvement in overall survival in combination with gemcitabine. This combination is another option for first-line therapy in patients with locally advanced or metastatic disease. Despite these recent advances, survival for patients with inoperable pancreatic cancer continues to be poor. Future investigations need to focus on understanding the molecular nature of this malignancy, with the goal of developing interventions based on this knowledge.
8 citations
TL;DR: Evaluation of the response rate, survival and toxicity of non-metastatic pancreatic cancer patients treated with a combination of Gemcitabine, Bevacizumab and Radiotherapy finds no significant differences in response rate or toxicity.
Abstract: 15043 Purpose: To evaluate the response rate, survival and toxicity of non-metastatic pancreatic cancer patients treated with a combination of, Gemcitabine, Bevacizumab and Radiotherapy. Materials ...